Increasing Colorectal Cancer Screening Among Hispanic Primary Care Patients: RE-AIM Analysis.

Context: Hispanic adults experience disparities in rates of colorectal cancer (CRC) screening. This RE-AIM analysis encompassed a multilevel decision support and navigation intervention (DSNI) for CRC screening. Interim findings were previously presented; we now aim to share the final analysis, particularly for effectiveness and implementation. Objective: Apply RE-AIM framework to a completed randomized controlled trial of a CRC screening intervention for Hispanic adults Setting: Five primary care practices Patients or Other Participants: Potential participants included a sampling frame of 2,720 screening-eligible patients, ages 50-75, Hispanic ethnicity, without history of CRC and polyps. 400 participants were enrolled. Intervention/Instrument: Decision support and navigation by a bilingual Patient Assistant (PA) as compared to a standard mailed intervention (SI) Main and Secondary Outcome Measures: 1) Reach- Study participants as compared to sampling frame 2) Effectiveness- Screening adherence 3) Adoption- Number of practice participants to complete intervention, engagement of patient and stakeholder advisory committee (PASAC) 4) Implementation- Quantitative data pertaining to patient contacts and communication of screening plan to primary care practices, Qualitative data on PA and Telephone Interviewer (TI) experiences 5) Maintenance- Health system dissemination (Pending). Results: 1) Reach- Study participants differed from the sampling frame in that ages 50-59 were overrepresented. There were no differences in race, gender, or language. 2) Effectiveness- Screening adherence was significantly increased in the DSNI group (73%) as compared to the SI group (44%) (OR=3.48, CI: 2.29-4.29,

Chapter 3, Hepatitis A: 3 --1 Chapter 3: Hepatitis A

ronic liver disease. II. Background In the United States, large nationwide epidemics have occurred approximately every 10 years, with the last increase in cases in 1995. 2 However, even between these epidemics, disease rates are relatively high and many communities experience periodic epidemics. Until recently, hepatitis A was one of the most frequently reported vaccine-preventable diseases in the U.S. with 20,000--30,000 cases reported to the NNDSS. In 2000, 13,397 hepatitis A cases were reported for a rate of 4.87 cases per 100,000 population. This is the lowest rate of disease ever reported in the U.S. and represents, after correcting for underreporting and asymptomatic infections, an estimated 57,000 cases and 143,000 infections, respectively. This remarkable decline in cases could be the result of vaccination of children, begun in selected areas in 1996. Based on testing from the Third National Health and Nutrition Examination Survey (NHANES III) survey conducted during 1988--

A Rural Perspective on Health Care for the Whole Person

The authors summarize the health care problems facing rural and frontier America by addressing five key issues within the framework of health care for the whole person: how to (a) provide health care access, (b) ensure health care quality, (c) provide a range of health care or meet the scope of practice demands, (d) address regional, rural-specific characteristics that may exist, and (e) address health professionals\u27 quality of life. When working in rural and frontier areas it is crucial for providers to collaborate across all types of health care to provide better care and better utilize a region\u27s tautly stretched resources. Rural health care resources are provided. The authors attempt to demonstrate characteristics of rural culture and rural and frontier populations\u27 health care disparities, highlighting the need for collaborative care. (PsycINFO Database Record (c) 2016 APA, all rights reserved

National Trends and Disparities in the Incidence of Hepatocellular Carcinoma, 1998–2003

Introduction Previous studies indicate that the incidence of hepatocellular carcinoma in the United States is increasing. These reports, however, have contained limited information on population groups other than whites and blacks.MethodsWe assessed recent incidence rates and trends for hepatocellular carcinoma by using newly available national data from cancer registries participating in the Centers for Disease Control and Prevention’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Data from registries in 38 states and the District of Columbia met our criteria; these data covered 83% of the U.S. population. We computed age-adjusted incidence rates and annual percentages of change from 1998 through 2003.ResultsThe registries that we used reported 48,048 cases of hepatocellular carcinoma (3.4 cases per 100,000 population per year) for the study period. Whites accounted for three-fourths of cases. The incidence rate for blacks was 1.7 times higher than that for whites, and the rate for Asians/Pacific Islanders was 4 times higher than that for whites. Hispanics had 2.5 times the risk of non-Hispanics. Among Asian/Pacific Islander subgroups, rates were highest for people of Vietnamese and Korean origin. For all races/ethnicities combined, the annual percentages of change were 4.8% for males and 4.3% for females (P < .05). The annual percentage of change was highest for people aged 45–59 years (9.0%, P < .05). The annual percentage of change for Asians/Pacific Islanders was statistically unchanged.ConclusionWe document rising incidence rates of hepatocellular carcinoma in the United States during a time when the overall incidence of cancer has stabilized. Efforts to collect representative etiologic data on new hepatocellular carcinoma cases are needed to enable better characterization of trends and to guide the planning and evaluation of prevention programs

ORIGINAL CONTRIBUTION Gun Storage Practices and Risk of Youth Suicide and Unintentional Firearm Injuries

THE PRESENCE OF A HOUSEHOLDfirearm is associatedwith an in-creased risk of suicide amongadults and adolescents.1-6 In a study of suicide attempters and com-pleters, investigators found that 75 % of the guns were stored in the residence of the victim, friend, or relative.7 The public health importance of house-hold firearms is a function both of the relative risk of exposure and the preva-lence of firearms in the environment of children and adolescents.8 Schuster et al9 estimated from the National Health Interview Survey that 35 % of homes in theUnited Stateswith children younger than 18 years reported owning at least 1 firearm, and that 43 % of these homes had at least 1 unlocked firearm. Re-ports from other surveys have derived similar estimates of the fraction of the population at risk from unlocked household firearms.10 Unloading and locking all guns and ammunition in the home can poten-tially reduceaccess togunsbyyouth.The policy issue of safe storage of firearms, both in legislative and clinical ap-For editorial comment see p 740. Author Affiliations are listed at the end of this article